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General NPI Number Information
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NPI Number | 1063630465
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS DENTAL ASSOCIATE, L.P.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 4343 W CAMP WISDOM RD STE 102
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City | DALLAS
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State | TX
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Zip | 75237-2467
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Country | US
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Telephone | 972-572-3552
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Fax | 972-572-3745
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Provider Business Mailing Address
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Address Line | 6300 WEST LOOP S STE 650
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City | BELLAIRE
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State | TX
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Zip | 77401-2997
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Country | US
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Telephone | 713-663-7960
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Fax | 713-349-8027
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Authorized Official
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Title or Position | OFFICER/PARTNER
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Name | BARRY JAMES GOMEL
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Credential | DDS
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Telephone | 713-663-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16570
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License Number State | TX
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